Journal club follow-up: Self medication and comorbid anxiety and substance use disorders

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This month’s journal club update was provided by Sarah.

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Journal Article Citation: Robinson, J., Sareen, J, Cox, B.J., & Bolton, J.M. (2011). Role of Self-Medication in the Development of Comorbid Anxiety and Substance Use Disorders: A Longitudinal Investigation. Archives of General Psychiatry, 68(8), pp. 800-807.

Link for abstract: http://archpsyc.jamanetwork.com/article.aspx?articleid=1107248

This month’s article raised some interesting points for discussion though there were no learnings made from the reading that were directly applicable to practice. There was some great critical analysis of the article – particularly what was missing from their article and it’s applicability to Australia.

Discussion Points:

 · The findings of the article confirmed the experience of the frontline workers – that those with symptoms of anxiety (whether know to the individual or not) are likely to be self-medicating using alcohol or other drugs.

· There was a comparison between participants who had a ‘diagnosable disorder’ and those who have ‘subclinical’ substance use or anxiety symptoms which was an interesting characteristic. Though this was likely because the writers were psychiatrists.

· There were some distinct limitations in the article (though the data seemed to quite robust with a large sample) – the majority of the participants were from rural areas, white and middle aged and it was discussed that this may have skewed some of their findings (e.g. that substance use disorders were predictive of social phobias). 

· Another limitation that was discussed was that there was likely to have been recall bias for the data collected on self-medication.
  

Also, Carina (from Goondiwindi) has suggested this article to read for those who are interested:

Journal Article Citation: Burns, L. & Teesson, M. (2002). Alcohol use disorders comorbid with anxiety, depression and drug use disorders. Findings from the Australian National Survey of Mental Health and Well Being. Drug and Alcohol Dependence 68(3), 299-307.

Link to abstract: http://www.ncbi.nlm.nih.gov/pubmed/12393224

 
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For a break-down of treatment types for anxiety disorder, including the use of substances for self medication, you may be interested in this resource from beyondblue:
 
Reavley NJ, Allen NB, Jorm AF, Morgan AJ, Purcell R. (2010) A Guide to What Works for Anxiety Disorders. beyondblue, Melbourne.
 
 
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